End AIDS by 2030? Not Without Harm Reduction

Last year, world leaders adopted the Sustainable Development Goals, which include a bold global target to end AIDS by 2030. While ambitious, this target is achievable, but only if governments redouble their efforts to prevent the transmission of HIV infection among those at risk, and their commitment to provide treatment to those living with the virus. In short, it requires governments to stand up against the stigma, discrimination and criminalisation that have driven the spread of HIV for decades, and embrace instead evidence- and rights-based responses.

People who inject drugs are among those who have been left furthest behind by the global response to HIV. Not only are people who inject drugs at increased risk of contracting the HIV and other blood borne infections thanks to a lack of access to sterile injecting equipment; they also suffer as a result of the stigma and criminalization associated with drug use, and the focus on criminalisation as the primary means of addressing drug issues. This has only served to fuel the epidemic among drug users, and it is unfortunately not surprising that the world missed the previous target of halving HIV among people who inject drugs by 2015 – by a staggering 80%.

Responding to the HIV risks linked to unsafe injecting is imperative if we truly hope to end AIDS. We know these risks can be minimised or even avoided altogether by providing access to harm reduction services – such as sterile needles and syringes, and prescription of substitute medications such as methadone. This is one of the reasons why each of us, during our tenures as UN Special Rapporteurs on the Right to Health, have consistently called upon States to provide access to harm reduction programmes as an essential component of their international legal obligations. People who use drugs do not forfeit their right to health simply by virtue of their drug use, and States cannot escape their universal human rights obligations simply because people happen to use drugs that are illegal.

Ending AIDS in this context is achievable with only minor changes in how governments spend their drug control resources. Statistical modelling published by Harm Reduction International shows that HIV-related deaths and new HIV infections could be cut by over 90% by 2030 if just 7.5% of global funding for drug law enforcement was redirected to scaling-up harm reduction. Despite the obvious benefits of such redirected spending, too many governments continue to neglect or even oppose harm reduction programmes, and adamantly continue to pursue criminalisation as their primary response. If the world continues to adopt harm reduction programmes at its current slow pace, it will be 2026 before every country which needs a harm reduction programme has even one service in place. In this context, we do not stand a chance of meeting goals to end AIDS by 2030.

‘AIDS-phobia’, the irrational fear of HIV, has long been a barrier to the development of comprehensive responses to the epidemic. When it comes to harm reduction and people who use drugs, it appears that too many governments also suffer from ‘evidence-phobia’ and ‘rights-phobia’. We know harm reduction works. It saves lives. It saves money. It promotes rights. Yet for too long, the flawed logic of fighting a ‘war on drugs’ has been allowed to trump the obligation to fight HIV as part of the fulfilment of the right to health. This approach must end if there is to be any hope of achieving the target of ending AIDS by 2030.

Despite the proven success in preventing HIV seen in countries that have scaled up access to harm reduction policies, last month’s UN General Assembly Session on addressing the world drug situation failed to garner support for harm reduction within the UN resolution that emerged from the meeting. Next month the General Assembly has another opportunity to right this wrong when they meet to specifically address the global response to HIV. And we urge them to take action. They must adopt a new target to prevent HIV among people who inject drugs. They must commit to fully funding harm reduction programmes. They must commit to removing the punitive frameworks that fuel mass incarceration, HIV epidemics and overdose. Only then do we truly stand a chance of ending AIDS by 2030. Only then can we realise a world where no one is left behind.

Dainius Puras, UN Special Rapporteur on the right to health, professor of child and adolescent psychiatry and public mental health at Vilnius university

Anand Grover, Former UN Special Rapporteur on the Right to Health, Designated Senior Advocate, Supreme Court of India, Director, Lawyers Collective, India

Paul Hunt, Just Fair Patron, Professor at the School of Law/Human Rights Centre, University of Essex, UK